The influence of dietary load on urinary oxalate and electrolytes was investigated in normal healthy subjects.
Under the load of a normal lunch, urinary oxalate, calcium, uric acid and magnesium excretion were increased by 11.8%, 38.4%, 7.1% and 27.8% respectively during 6 hours after the meal.
Under the load of an oxalate-rich lunch (containing 150g spinach fried in oil), urinary oxalate excretion was surprisingly increased. Conversely, urinary calcium and magnesium excretion were remarkablly decreased.
Under the load of an oxalate and animal protein rich lunch, urinary oxalate excretion was decreased, and urinary calcium excretion was increased compared with the oxalate rich lunch loading.
Under the load of an oxalate and animal protein rich lunch, urinary calcium excretion was significantly higher in calcium stone formers than in normal healthy subjects but urinary oxalate excretion in calcium stone formers was equal to that in normal healthy subjects.
From thease results, and from other nutritional reseach on Japanese stone formers (Urologica Internationalis, 39:32, 1984), it can be said that calcium restriction alone is not sufficient for the prophylaxis of renal stone disease and individual dietary guidance should be the primary measure.
This general dietary guidance should be advised.
a) high fluid intake
b) prolongation of the time between dinner and sleep
c) avoidance of making the evening meal the main meal (there should be a balance of meals throughout the day)
d) correction of unbalanced diet; the diet should include all kinds of food.

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The second and fourth sacral nerves, which seem to have an important role in urination, are not related clearly to the mechanism of the detrusor and external sphincter.
In this study, electrical activity of the 4th sacral nerve and EMG of the external sphincter during urination were studied percutaneously in normal rabbits and experimental neurogenic bladder models in rabbits, in order to know the role of the 4th sacral nerve in relation to the mechanism of urination.
The normal pattern of 4th sacral nerve activity according to dynamics of the urinary bladder in normal rabbits is as follows:
1) Gradual increase of electrical activity on increasing bladder volume.
2) The most frequent activity is obtained at the point of starting urination.
3) Gradual decrease of electrical activity on decreasing bladder volume.
And in two types of neurogenic bladder in rabbits, abnormalities of the 4th sacral nerve were demonstrated.
In these results, the 4th sacral nerve activity copying with bladder activity were demonstrated. By observing EMG of the external sphincter and electrical activity of the sacral nerve, we can obtain more precise information on urodynamics especially in case of neurogenic bladder.

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The second, third and fourth sacral nerves, which seem to have an important role in urination, are not related clearly to the mechanism of the detrusor and the external sphincter.
In this study, electrical activity of the 4th sacral nerve and EMG of external sphincter during urination were studied percutaneously in 8 patients with neurogenic bladder, in order to know the role of the 4th sacral nerve in relation to the mechanism of urination.
Bipolar needle electrodes were inserted into the sacral foramen percutaneously by the method of sacral nerve block.
The normal pattern of the 4th sacral nerve activity during urination in humans is similar to that in normal rabbit as stated below.
1) Gradual increase of electrical activity on increasing bladder volume.
2) The most frequent activity is obtained at the point of starting urination.
3) Gradual decrease of electrical activity on decreasing bladder volume.
And in three types of neurogenic bladder in patients, abnormalities of the 4th sacral nerve were demonstrated.
The second sacral nerve activity during urination was studied in some cases.
The 4th sacral nerve activity reflected well the bladder activity and the 2nd sacral nerve activity the sphincter activity.
By observing EMG of the external sphincter and activity of the sacral nerve in combination, we can obtain more precise information on urodynamics especially in case of neurogenic bladder. This type of study on sacral nerve activity may be called uroneurometry.

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Using radioligand binding assays, both α₁ and β adrenergic receptors of the human normal and hypertrophied prostatic tissue were quantitated, for the first time. For α₁ adrenergic receptor assay, with ³H-prazosin as a ligand, the prostatic crude membrane fraction were incubated for 20min. at 30°C with or without 10μM phentolamine. The number of binding sites (NBS) and the dissociation constant (Kd) were calculated from the Scatchard analysis.
The number of binding sites of α₁ adrenergic receptors in the normal prostatic tissue was determined 35.7±12.7fmol/mg protein (mean±S. D.), on the other hand, the NBS of it in the hypertrophied prostatic tissue was 50.3±14.6fmol/mg protein. In the hypertrophied prostate it was noticed that there was a significantly greater density of α₁ adrenergic receptors than in normal prostate (p<0.05), although there was no difference in Kd between them.
It has recently been revealed that the human prostatic smooth muscle elicited supersensitive contractions to α₁ adrenergic stimulants in benign prostatic hypertrophy, in vivo and in vitro. This supersensitive reaction seems to be due to the increase of α₁ adrenergic receptors density in the hypertrophied prostatic tissue. Furthermore, it was speculated that the greater density of α₁ adrenergic receptors in the hypertrophied prostate was caused by the denervation effect in the tissue.
For β adrenergic receptor assay, ³H-DHA (dihydroalprenolol) was used as a ligand. Although the incubation was performed for 30min. at 25°C, the method of binding assay was similar to the α₁ adrenergic receptor assay. No difference in the NBS of β adrenergic receptors was revealed between normal and hypertrophied prostatic tissue. Lower affinity of β adrenergic receptors was obtained in the benign prostatic hypertrophy than normal prostate.

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Urinary oxalate excretion was measured by the modified Snell & Snell method in 20 normal subjects and 100 stone-formers of the upper urinary tract, including 29 calcium oxalate stone-formers, 47 calcium oxalate and calcuim phosphate stone-formers and 24 other stone-formers. There was a significant difference in the 24-hour urinary oxalate excretion between the calcium oxalate stone group (44.0±21.0mg/day) and the control group (30.3±11.6mg/day) (p<0.01), but there was no significant difference between the other 2 stone groups and the control group. It is suggested that the significant increase in the urinary oxalate excretion is regulated by the significant increase in the urinary oxalate concentration in the calcium oxalate stone group.
In all 3 stone groups, no significant difference in urinary oxalate excretion between the nonrecurrent stone-formers and the recurrent stone-formers is noted, but the urinary oxalate excretion of the recurrent stone-formers is larger than that of the non-recurrent stone-formers.
In the calcium oxalate and calcium phosphate stone groups, there was no significant correlation between the percentage of calcium oxalate in each stone and the urinary oxalate excretion.
The calcium-restricted and oral-tolerance tests were performed in 20 patients with calcium oxalate stones or calcium oxalate and calcium phosphate stones, and the urinary oxalate excretions were examined. The urinary oxalate excretions in the calcium-tolerance test showed a significant decrease compared to that in the calcium-restricted test (p<0.05). These data suggested that calcium participated in the absorption of oxalate of the intestine. In 17 idiopathic hypercalciuric patients, 24-hour urinary calcium and oxalate excretion using the same samples was examined, however, no correlation was detected.
In conclusion, hyperoxaluria appears to play a role in the stone formation in patients with a pure calcium oxalate stone.

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102 passed stones which had been analysed by X-ray diffraction and infrared spectroscopy and found to be composed of calcium oxalate and apatite were studied by thermal analysis to determine the contents of weddellite, whewellite, apatite and organic matrix. The results are as follows:
1) There was a statistical correlation between the ratio of weddellite to weddellite plus whewellite determined by thermal analysis and that determined by X-ray diffraction (r=0.954).
2) There was a statistical correlation between the apatite content determined by thermal analysis and that determined by infrared spectroscopy (r=0.807).
3) The content of organic matrix was 3.8±2.2% (mean±S. D.), with a range of 1.1 to 17.2%. The content of organic matrix was correlated with the whewellite content (r=0.708) and with the apatite content (r=0.517).
The stones then were divided into 3 groups according to the principal constituent: weddellite, whewellite and apatite groups.
4) The stones of the weddellite group were significantly heavier than those of the whewellite group (p<0.01) and also seemed to be heavier than those of the apatite group.
5) The apatite content was correlated with the ratio of weddellite to weddellite plus whewellite in the weddellite and whewellite groups (r=0.528) and in the apatite group (r=0.742).
Thus, it is considered that the weddellite-apatite and whewellite-organic matrix associations have important roles in the development and growth of weddellite and whewellite calculi, respectively.

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Intravesical use of anti-tumor solution either for treatment of prophylaxis of recurrence of the bladder tumor has been employed world widely. However, the therapeutic dose of these anti-tumor solutions are often too much irritative to the bladder mucosa.
For the past 5 years, we have been employing continuous instillation of diluted and non-irritative anti-tumor solutions for consecutive three days immediately after transurethral resection of the superficial bladder tumor, to prevent potential dissemination and implantation of the tumor cells to the resected surface or to the other area of the bladder wall.
Three kinds of anti-tumor solutions were prepared for this stidy; 40mg of Mitomycin-C, 120mg of Bleomycin and 100mg of Adriamycin are dissolved in 2000ml of saline solution.
During the past 12 years, we have experienced 232 bladder tumor cases. Among them, 94 patients during the past 5 years were submitted for this study and 81 of them have been under our consecutive observation up to present.
Of these 81 cases, 30 were treated with Mitomycin-Cm 34 with Bleomycin and remaining 17 with Adriamycin solution. Instillation was performed through a 3-way Foley catheter at the rate of 2, 000ml in 24 hours and repeated consecutively for 3 days.
The recurrence rate of the bladder tumor after initial treatment with Mitomycin-C solution was 41% in 4 years. The recurrence rate with Bleomycin and Adriamycin solutions were 25% and 30% respectively in 5 years, whereas that of the control group was 63%.
None of the cases complained of bladder irritation during the treatment. In 2 cases of Adriamycin group, the instillation therapy had to be discontinued because of the remarkable increase in postoperative hemorrhage.
The results so far obtained with this technique are highly encouraging in reducing recurrence rate of the superficial bladder tumor after transurethral resection.

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A new equipment based on field gradient principle for measurement of related values of urethral pressure and cross sectional area has been developed. Inside a probe consisted of a Fr. 9 polyvinyl two lumen catheter, there are 4 ring impedance electrodes and a balloon which is distended with saline is placed around the electrodes for measuring urethral pressure and width.
Obtained parameters were reproducible, and this is considered to be a useful method for clinical evaluation of urethral function.
In a patient with benign prostatic hypertrophy, urethral compliance and musclular contraction function of the urethral external sphincter was examined postoperatively by this method. The proxymal urethra had a better compliance in conparison with the distal segment, and voluantary contraction was noted remarkably in the external sphincter.

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A total of 159 cases of renal cell carcinoma received treatment at the Jikei University Hospital during the 20 years' period from 1963 to 1982 were reviewed. Metabolic syndrome i was seen n 86 (54.1%) out of these cases, in 14 cases (8.8%) of which it was present without any other symptoms. Among the symptoms of metabolic syndrome, the commonest one was fever which was seen in 61 cases (38.4%), followed by weight loss in 36 cases (22.6%), general malaise in 35 cases (22.0%), anorexia in 30 cases (18.9%), gastrointestinal symptoms in 15 cases (9.4%) and varicocele in 15 cases (9.4%). Fever was a frequent symptom in cases which had renal mass and it was often accompanied by accelerated erythrocyte sedimentation rate and hepatic dysfunction. Although it was not correlated with the stage, its incidence was high in high graded cases, indicating poor prognosis. In 6 (40%) out of 15 cases of varicocle, hepatic dysfunction was seen as the complication. Most of the other symptoms of metabolic syndrome were seen more frequently in cases with high grade and stage than in those with lower grade and stage. The hematological syndrome included anemia in 33 cases (20.8%), polycythemia in 3 cases (1.9%) and accelerated erythrocyte sedimentation rate in 96 cases (60.4%). Anemia was not related to the presence or absence of hematuria, but it was seen more frequently in high graded and staged cases. The incidence of accelerated erythrocyte sedimentation rate was higher for cases with high grade and stage, and it was associated with fever, increase in α₂-globulin and anemia in most of the cases. The prognosis of thses cases was poor. As the biochemical syndrome, hepatic dysfunction was seen in 21 cases (13.2%), increase in α₂-globulin in 91 cases (57.3%) and hypercalcemia in 13 cases (8.1%). Hepatic dysfunction was not related to either the grade or the stage of tumor. Increase in α₂-globulin was seen more frequently in cases with high grade and stage. In many of these cases it was associated with anemia and acceleration in sedimentation rate, with poor prognosis.

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Tumors in 515 patients presenting initially with superficial bladder tumor (Ta, Tl) were analyzed for intravesical recurrence and malignant progression during a follow-up period of at least 2 years (average 3 years and a half). Intravesical recurrence was found in 237 cases and malignant progression in 38 cases. Significant risk factors for intravesical recurrence were initially multiple tumor, positive cytology and grade 2 tumor. Significant risk factors for malignant progression were positive cytology, histologically high grade tumor and frequent (more than once a year) intravesical recurrence. Growth pattern, size and multiplicity of the initial tumor were likely to related to progression but were not significant factors. Patient with these risk factors should be carefully followed up and urine cytology during the follow-up period seemed to play an important role in early detection of malignant progression.

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Intratubular atypical germ cells (ATGC), prepared from the peripheral tissue of two cases of human seminomas, were examined ultrastructurally. Most of ATGC were located close to the basal lamina and showed a oval shape. The intercellular bridges were never seen. The nuclei which had a diameter of about 12μm, were eccentrically placed with cytoplasmic organelles in the remaining area. The nuclei were round to oval in shape and smooth in contour. The nucleoli were centrally placed in the nucleus and most of them showed thread like configurations. Oval shaped mitochondria which lacked intermitochondrial cementing substance, free ribosomes and elongated rough endoplasmic reticulum were prevalent in the cytoplasm.
The nuclei of the Sertoli cells were mostly round to ovoid in shape and had less indentation than that of mature Sertoli cells.
The tubular walls were thickened with laminated basal laminae and thick collagen fibers.
Clusters of tumor cells were found in the interstitium with Leydig cells. The fine structures of the tumor cells were almost identical with those of other seminoma cells, except that the clusters were often surrounded by a thin layer of basal lamina and incomplete bundles of collagen fibers. The Leydig cells seemed to be in a state of degeneration.
Intratubular ATGC are now considered to be a preinvasive lesion of the testicular tumors. Therefore we think much attention ought to be paid to this type of lesion.

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1) Clinical studies were done on 32 patients with penile carcinoma treated during the last 20 years at our department (1963-1983). The average age was 58.6 years old, ranged from 33 to 88 years old. Intervals between the time of onset and the time of the first visit to our department ranged from 8 days to 5 years. Thirty-one of the 32 patients had phimoses. The tumors were classified according to the Jackson's staging system and TNM classification. With the Jackson's system, 11 patients had stage I, 15 stage II, 5 stage III and 1 stage IV, 81% of the patients having stage I and II disease. With the TNM classification, 1 patient had T_1s, 12 T₁, 10 T₂ 7 T₃, 2 T₄. Histopathological diagnosis of all patients was squamous cell carcinoma. Treatment consisted of surgery, radiation and chemotherapy. Treatment was done mainley by combination of surgery and chemotherapy with Bleomycin. The overall 5-year survival rate was 86%. The 5-year survival rates with the Jackson's staging system were 99.0%, 82.0%, 80.9% and 0%, respectively, for stage I, II, III and IV disease.
2) One hundred eighty nine autopsy cases of penile carcinoma selected from the Annual of the Pathological Autopsy Cases in Japan during 18 years were studied. The average age was 57.8 years old, ranged from 25 to 87 years. One hundred fifty two of 189 cases (80.4%) had histopathological diagnosis of squamous cell carcinoma. Of this series, 8 (5.6%) had double cancer. Of 144 cases with squamous cell carcinoma, 111 had local infiltration of the tumor or metastasis. In 94 cases lymph node were involved and in 32 cases information about lymph nodes was not available.

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A case of carcinoid tumor of kidney is presented. The patient was a 62-year-old woman in whom a mass with ring-shaped calcification of the left kidney was found when she underwent abdominal CT scanning following the examination of gastrointestinal tract for constipation. The examination of gastrointestinal tract and urinalysis showed no abnormality. The hematological and biochemical findings suggested chronic hepatitis. Plain films of the abdomen revealed calcification in the left upper quadrant. Excretory urograms showed a deformity of the left collecting system due to a mass lesion with calcification. Selective renal arteriography showed displacement of the intrarenal arteries but no tumor vessels or tumor stain. The patient was diagnosed as having a left renal tumor and radical nephrectomy was undertaken on February 22, 1982.
The surgical specimen was 11.5×5.5×5.0cm in size and 197g in weight. On a cut surface, the tumor was 8.5×4.0cm in size and encapsulated in the central part of the kidney. Histological examinations showed that the tumor had a tubular structure and massive cell nests in part. The nuclei were small and round, existing ubiquitously at the basal part of cells. Hemorrhage and calcification were remarkable. Although the tumor showed negative reaction of Grimelius stain and Masson-Fontana stain, the lesion was diagnosed as carcinoid based on its cellular arrangement. Neurosecretory granules were also observed in cytoplasms by electron microscopic examination. The retroperitoneal lymph nodes were demonstrated to have metastases, but no findings of carcinoid syndrome were revealed either preoperatively or postoperatively. At present, two years and four months after surgery, clinical course of the patient is uneventful, without sings of recurrence or metastasis.
Nine patients with carcinoid originating from the kidney were reported in the literature. The mean age of the 10 patients including our patient was 49.6 years. Typical carcinoid syndrome was observed in only one of them. Preoperative diagnosis was very difficult and arteriograms showed avascular tumors. Lymph node metastasis was observed in 62.5% of cases.

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Three cases of renal cell carcinoma with tumorous caval thrombus experienced in 2.5 years are presented and the symptoms and treatment of such cases are discussed.
According to the various reports, symptoms of the caval thrombus, including pedal edema, varicocele, proteinuria, liver dysfunction etc. appear in only 7 to 30%. Therefore, it is important to note that lack of these symptoms scarcely indicates the absense of caval thrombus and reverse assumption may even be harmful.
Radical nephrectomy with removal of the caval thrombus is essential for the treatment. If the remaining kidney is on the right side, and segmental resection or tying of vena cava is needed for the removal of caval thrombus, there are some reports that right reno-portal anastomosis should be done, because the right kidney usually has poor collateral veins. In the 3rd case, we were able to reconstruct the inferior vena cava instead of making renoportal anastomosis and the result is satisfactory.
Operative indications for renal cell carcinoma with both of caval involvement and distant metastases are controversial. Though the 1st case had multiple lung metastases, many of them were getting smaller and some of them disappeared after radical nephrectomy with cavotomy followed by immunochemotherapy at 25 months post operatively. This particular case belongs to “minor response” according to Koyama-Saito's criteria of Japan.
Therefore, we believe that there is a possibility to increase survival rate of such cases by multidisciplinary treatment including positive surgical approach.

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Müllerian duct cyst is generally thought a very rare disease except in patients with sexual development disorders, such as hypospadia. In Japan, only 5 cases in normal males are in the literature. But the detection rate of this anomaly at autopsy was 0.7 to 1.0%.
We examined ultrasonically the prostates of 660 patients by intracorporeal electronic linear scanning during the last 4 years and 4 months, and found out 7 cases (1.1%) which demonstrated cystic image (1.5 to 3.0cm. in diameter) in the posterior midline portion of the prostate in echogram.
Four cases (0.6%) of them whose complaints were due to BPH and/or prostatitis underwent trans-perineal or transrectal ultrasonically guided cyst puncture and samll-sized cystograms could be obtained in all cases by radio-contrast medium injection.
The appearances of echogram and cystogram with retrograde urethrogram enabled us to diagnose them all Müllerian duct cyst and TUR was done in 1 case.
Müllerian duct cyst shows pear-shaped cystic image in the median lobe of the prostate in echogram and can be diagnosed by ultrasonically guided cyst puncture which is easily monitered by trasnrectal electronic linear scanning. The detection rate with ultrasound agreed with that at autopsy.

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